Cardiac Magnetic Resonance: One Slice, Two Different LGE Patterns.

Area of Science:

• Cardiology
• Medical Imaging

Background:

• A 56-year-old male with a history of myopericarditis presented with chest pain and elevated myocardial necrosis markers.
• Initial assessment included electrocardiogram (EKG) and echocardiogram, revealing EKG changes and signs of myocardial dysfunction.

Observation:

• Cardiac magnetic resonance imaging (CMRI) was performed on day 7 post-admission.
• CMRI demonstrated increased T2-short tau inversion recovery (T2-STIR) signal in the inferior wall.
• Two distinct late gadolinium enhancement (LGE) patterns were observed: an ischemic-like pattern in the inferior wall and a subepicardial pattern in the inferolateral wall, along with pericardial LGE.

Findings:

• Coronary angiography revealed three-vessel disease.
• The CMRI findings suggested a complex interplay of ischemic and non-ischemic pathologies, including pericardial involvement.

Implications:

• This case underscores the diagnostic capability of CMRI in identifying unusual and unexpected pathological patterns in cardiac conditions.
• CMRI provides crucial insights beyond conventional imaging, aiding in the understanding of complex cardiovascular presentations.